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PURPOSE: Malone antegrade continence enema has been a successful and widely used procedure for achieving fecal continence in children. We present data on the previously uninvestigated issue of patient and caregiver regret following surgery for intractable constipation and fecal incontinence. MATERIALS AND METHODS: We reviewed all patients undergoing antegrade continence enema or cecostomy creation at a single institution between 2006 and 2016. Patients and caregivers were assessed for decisional regret using the Decisional Regret Scale. Results were correlated with demographics, surgical outcomes and complications. RESULTS: A total of 81 responses (49 caregivers and 32 patients) were obtained. Mean followup was 49 months. Decisional regret was noted in 43 subjects (53%), including mild regret in 38 (47%) and moderate to severe regret in 5 (6%). No statistical difference in regret was noted based on gender, complications or performance of concomitant procedures. On regression analysis incontinence was strongly associated with decisional regret (OR 4.4, 95% CI 1.1–18.1, p

p 1⁄4 0.009), male sex (OR 1.83, p 6 (OR 1.64, p 1⁄4 0.002). These same factors were independently associated with risk of unfavorable pathology: size > 2.5 cm (OR 1.53, p1⁄40.006), male sex (OR 1.90, p 6 (OR 1.54, p 1⁄40.024) Tables 1 and 2 show the risk of RCC and unfavorable pathology, respectively. CONCLUSIONS: The treatment of cT1a renal masses must include a discussion of the likely pathologic outcome for each patient. In this multi-institutional cohort, imaging tumor size >2.5 cm, male sex and nephrometry score > 6 were predictors of RCC and adverse pathology following PN. These factors may assist in risk stratification and selective renal mass biopsy prior to decisionmaking. Further studies are necessary to validate these findings.

INTRODUCTION AND OBJECTIVES: The number of robotassisted radical prostatectomy (RARP) in Japan is increasing rapidly due to the application of health insurance to robotic surgery for prostate cancer since April, 2012. To maintain patient safety and high quality of surgery, the implementation of robotic surgeries in our institution were controlled by the minimal invasive surgery center (MISC), which runs robotic surgeries comprehensively. We report our experience of treating patients in MISC together with outcome of RARP. METHODS: The MISC consisted of all the departments related to robotic surgery including anesthesiology, five surgery departments, operation room nurses and medical engineers. From the view of safe implementation of robotic surgery, a certificate for surgery type and the console surgeon were authorized by MISC. Specifically, the MISC has a 0termination order0 authority, which is applied when there is excessive bleeding or surgical time. Robotic surgery must be changed into other types of surgery such as open conversion once the order is given. Each robotic surgery case in five surgery departments is checked and discussed preand post-operatively in the regular meeting held by MISC twice a month. RESULTS: The case number results stratified by robotic surgery types in the MISC over the last 2 years are shown in Table. The Urology, gynecology, respiratory surgery, digestive surgery and otorhinolaryngology departments performed 176, 22, 43, 34 and 2 cases of robotic surgeries, respectively. The number of cases with major complications including Clavien 5, 4 and 3 in all 277 cases were 0, 0 and 6 (2.2 %), respectively with one case of intra-operative open conversion. The core of robotic surgeries in MISC was RARP, and the implementation of this surgery based on the concept of pentafecta was supervised by MISC. At the median follow-up time of 11.9 (range 1.3 27.3) months, the positive surgical margin rate was 15.8 %, 91% of patients had undetectable PSA levels, and 76% of patients were not using pads. CONCLUSIONS: This is the first report of robotic surgery cases that were implemented using the constitutional framework of an academic institution. The MISC is providing immeasurable benefits from the aspects of patient safety and education for the robotic surgical team, and ultimately lead to accomplishment of pentafecta of RARP in urology.